“It was a feeling of a safety net”
COVID- 19 relief funds kept Colorado health care providers afloat
There is no masking when it comes to dental work. Mouth agape, each patient is a potential coronavirus spreader who can grind a dentist’s office to a halt in a matter of days. It happened to Blanchard & Richardson Family Dentistry, where just a single hygienist forced to quarantine with a COVID- 19 infection meant up to 50 appointments — and thousands of dollars in revenue — wiped from the books in one week.
The Littleton dental practice received nearly $ 109,000 from the U. S. Department of Health and Human Service’s COVID- 19 Provider Relief Fund to help it muddle through the pandemic — a tiny fraction of the nearly $ 1.7 billion hospitals and medical clinics across Colorado have received from the fund in the past 25 months.
The money went to cover the costs of staff members’ salaries, to cover personal protection equipment or to help clinics and doctor’s offices stand up telemedicine systems on the fly.
Arapahoe County received the largest slice out of Colorado’s 64 counties — $ 345 million as of mid- January — money that went to nearly 1,000 medical providers, ranging from giant hospital companies to cancer clinics to ambulance services to dental and chiropractic offices.
According to data analysis from The Denver Post, hospital systems such as Centennial- based Centura Health came out on top, receiving nearly $ 200 million in provider relief funds to distribute to its 17 hospitals in Colorado and Kansas.
By contrast, tiny Evans Chiropractic in Littleton got $ 2. “The relief funds helped them to keep their offices open,” said Colorado Medical Society President Mark Johnson. “There would have been an even greater shortage of physicians without these funds.”
Johnson, who led Jefferson County Public Health for more than three decades, said doctors who weren’t part of a hospital or large health care outfit were hardesthit by the pandemic, losing one- half to two- thirds of their outpatient business as lockdowns and fear overtook Colorado.
“One of the biggest issues was that people were afraid to go anywhere,” he said.
Johnson said the $ 186.5 billion that HHS has distributed nationwide as part of the provider fund over the past two years has been critical to keeping an overburdened health care system from collapsing under the weight of a relentless pandemic that has claimed more than 13,000 lives in Colorado, about 1 million nationwide and more than 6 million across the world.
“We came close in a number of states to breaking the system, and it would have broken if it hadn’t been for the provider relief funds,” Johnson said.
The Denver Post profiled a number of medical providers, from the big to the small, to find out how they used funds from the Provider Relief Fund. Here are their stories.
The cancer clinic ($ 9.6 million)
The email came on April 10, 2020 — Good Friday — informing Glenn Balasky, executive director of the Rocky Mountain Cancer Centers, that his 13 clinics up and down the Front Range would be getting money from the provider relief fund.
It had been exactly one month since Gov. Jared Polis had declared a public health emergency, and the effects of the pandemic were hitting the state’s medical community hard. For the first six months of the pandemic, Balasky said Rocky Mountain Cancer Centers lost revenue from canceled appointments, as patients stayed home to avoid potential exposure to the coronavirus.
The Greenwood Village- based oncology operation — with 700 employees supporting 58 doctors and 40,000 patients annually getting treatment for cancer or blood diseases — received $ 9.6 million from the provider relief fund.
“The funds were critical not only at the time but over the course of the pandemic,” Balasky said. “It was a feeling of a safety net — the government recognizing it doesn’t know what’s going to happen. But as the big brother in our arena, they were the only ones that could help out immediately.”
The money, as with many medical providers, went to cover the cost of personal protective equipment, which had shot up in price because of shortages and fierce competition. It also went to help keep paychecks whole for existing staff members and to pay screeners who were now required to vet people coming into the clinics.
But one of the big unanticipated costs put upon Rocky Mountain Cancer Centers by the pandemic was establishing the means and infrastructure to treat people from afar. It’s something the organization hadn’t done much with before COVID- 19 hit Colorado, Balasky said.
“Telemedicine was suddenly upon us,” he said. “We had to add computers, software programs, microphones and pay for software licenses to do telemedicine with patients.”
But cancer being what it is, Balasky said, his organization could engage in remote visits only to a certain degree. In the end, the company kept its clinics open throughout the entire health crisis.
“Even if we wanted to close our doors, you can’t treat cancer at home,” he said. “Cancer did not take a break for COVID.”
The hospital ($ 3.4 million)
As a potential ground zero location for COVID- 19 transmission, Craig Hospital in Englewood essentially had to shutter its outpatient business during the first few months of the pandemic — at a cost of $ 6 million.
“Until we knew what we were dealing with, we were trying to be very cautious about who we were letting into the building,” said Dan Frank, Craig’s chief financial officer. “We were shut down to about 5% of our total outpatient volume for several months.”
The $ 3.4 million Craig received in federal provider relief funds was critical in avoiding layoffs at the rehabilitation facility that specializes in spinal cord and traumatic brain injuries, Frank said. The hospital employs about 1,000 people and sees 1,800 patients annually. “That $ 3.4 million helped us maintain full employment,” he said.
And the rigorous measures Craig took to ward off the coronavirus allowed Craig to go without any COVID- 19 cases until the ultracontagious omicron surge arrived in December. But keeping the facility virus- free for the first 21 months of the pandemic didn’t come without a price tag.
Aside from the near closure of its outpatient business, Craig incurred additional expenses it wasn’t anticipating in its efforts to manage the explosion of coronavirus in its midst.
The hospital had to establish negative airflow rooms to minimize virus transmission in sensitive settings, hire additional workers to screen visitors entering the building and make a costly foray into telemedicine as more medical appointments went virtual.
“We created a telemedicine program from scratch in the early days of COVID,” Frank said.
Not being a part of a large corporate hospital system, Craig wasn’t in line for as much federal COVID- 19 relief money and didn’t have the economies of scale to help defray some of its costs. By contrast, Centennial- based Centura Health received $ 187 million in provider relief funds, which represents the lion’s share of Arapahoe County’s take in that category.
Because Centura Health owns 17 hospitals in Colorado and western Kansas, including Longmont United and Orthocolorado in Lakewood, much of that money did not stay in Arapahoe County. But the funds were critical in facing “historic and unprecedented challenges” across its entire system, said Centura spokesman Kevin Massey.
“These relief funds were used to fund new expenses Centura Health incurred for supplies and pharmaceuticals, including personal protective equipment for our caregivers, COVID- 19 testing and vaccinations, equipment and facilities to handle COVID- 19 patients and surges, enhanced telehealth access, and additional labor expenses throughout the pandemic,” he said.
Centura, Massey said, also gave “appreciation pay” to its employees, along with child care, grocery shopping support and free meals to keep up morale among workers in an industry that got walloped by the pandemic.
Despite the millions of dollars in federal assistance, the revenue “did not fully cover all of Centura’s additional pandemic expenses, let alone the significant lost revenue experienced during shutdowns and multiple surges,” Massey said.
The ambulance service ($ 467,000)
The budgetary wallop for Centennialbased South Metro Fire Rescue from the pandemic was big: more than a million dollars lost in 2020 compared with 2019, as COVID- 19 made people hesitant to summon help for medical emergencies.
Transports by ambulance fell by 800 in 2020 from the prior year despite a growing population across South Metro’s 300- squaremile service area, which is largely centered on Arapahoe County. At $ 1,270 a ride, and an additional $ 15 per mile, the losses added up, said Eric Hurst, a spokesman for South Metro.
“We saw a decrease in people calling 911, but people were sicker when they did call,” Hurst said. “Regardless of what’s going on in the world around us, our community still relies on the fact that when they dial 911, they get help quickly.”
That means having to stand up 19 ambulances across 30 fire stations for the more than half a million people in its jurisdiction — even when traffic is down.
“To maintain that, those funds certainly helped to make up a good part of that revenue loss,” Hurst said of the $ 467,000 his agency received in provider relief funds from HHS.
South Metro had other expenses from the pandemic. It had to buy a decontamination system for its fire stations, where it sprayed a hydrogen peroxide- based solution on equipment and vehicles to kill any traces of the virus.
Early on, Hurst said, the 700employee agency tasked one worker to drive around with a mobile sprayer to do the cleaning before South Metro got the decontamination system into all of its stations.
“That went on for several months — there was one person whose full- time job was decontaminating ambulances from hospital to hospital,” he said. “They would put on a low- level hazmat suit with special boots and they would clean the back of the ambulance and the stretcher.”
The hospice ($ 157,000)
When Mike Weldon, executive director at Aurora’s Sun Tree Hospice of Colorado, saw the average stay of patients drop from 120 days to around 40 as the pandemic tightened its grip in 2020, he knew he was operating in a crisis environment.
“When that number drops like that, that means something huge is going on,” he said. “People are dying really quickly.”
And because older people have been particularly susceptible to the virus, Sun Tree doctors, nurses, chaplains and caretakers had to be especially protected before seeing a patient so as not to infect them.
“All of us were trying to ramp up personal protective equipment so we could still serve people,” Weldon said. “Paying people more was a thing; getting people to cover shifts was a thing.”
Sun Tree, which serves about 50 patients during their final months of life at hospitals, nursing homes and in private residences, received nearly $ 157,000 in Provider Relief Funds.
Weldon said many of their patients contracting with his hospice were in noticeably worse shape than had been the case before the pandemic.
“We received a lot more postacute referrals than we would typically,” he said.
But Sun Tree was able to preserve its staffing levels during the pandemic, maintaining a 92% retention rate. And the hospice got a little help from Ford Motor Co., which sent it 500 face shields free of charge.
“I didn’t lay off anybody during the pandemic,” Weldon said.
The dentist ($ 109,000)
The big strike against Dr. Brian Richardson’s Littleton dental
practice came during the seven weeks he was forced to shut down by state order early in the pandemic. With 15 employees to pay and $ 15,000 in monthly rent to cover, it quickly became a sink- or- swim issue.
“Initially we lost a ton of money,” Richardson said of that trying time in March and April 2020. “The funds went to pay wages during the time when we weren’t getting any revenue.”
In all, Blanchard & Richardson Family Dentistry secured nearly $ 109,000 in provider relief funds from the federal government, about which Richardson says he is “extremely grateful.”
“I could have stayed in business without it, but it helped me not have to make substantial changes to my business,” he said of his 20- year- old practice just north of the Douglas County line.
COVID- 19 infections among his staff members were an additional burden on business, Richardson said. When one was forced to quarantine, 40 to 50 patients were taken off the schedule book in a single week.
“We just ended up canceling patients,” he said.
The recent labor shortage also hit Blanchard & Richardson hard. His Craigslist ads for dental hygienists have yielded three applicants, one of which demanded a negative pressure room in which to work. Richardson ended up persuading a 60- year- old neighbor, and retired dental hygienist, to return to the office to help manage the patient load.
Then there was the skyrocketing cost of personal protective equipment in his office to contend with. A box of gloves climbed from $ 10 a box to $ 40.
“It’s been ridiculous how much some of these supply costs have gone up,” Richardson said.
And because his practice is not part of a corporate chain of dentist’s offices, he can’t absorb the advancing prices as easily as the big players can.
“I don’t have the ability to go in and negotiate contracts with suppliers or insurance,” Richardson said. “It doesn’t mean we’re charging more — it just means we can’t scale down costs.”